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The autonomic nervous system and sudden death.
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1998
Year
HypertensionHeart FailureSudden DeathSocial SciencesCoronary Artery DiseaseAutonomic Nervous SystemAcute Myocardial InfarctionPsychophysiologyCardiac MortalityAtherosclerosisCardiologyAutonomic Nervous System AnatomyMyocardial InfarctionAutonomic SystemNervous SystemHeart Rate VariabilityCardiac ArrestCardiovascular DiseaseNeurophysiologyAutonomic ActivityMedicineEmergency MedicineAnesthesiology
Autonomic activity markers such as heart rate variability and baroreflex sensitivity have emerged as potential prognostic indicators of cardiac mortality, especially during acute myocardial ischemia. This chapter reviews experimental evidence that underpins the use of autonomic markers for post‑myocardial‑infarction risk stratification. It examines clinical studies, notably the ATRAMI multicentre prospective trial of nearly 1,300 post‑MI patients, assessing the prognostic value of heart rate variability and baroreflex sensitivity. The authors discuss pathophysiological insights that question the validity of current terminology used in autonomic‑marker‑based clinical studies.
The knowledge progressively accumulated on the relation between changes in autonomic activity and cardiac mortality, particularly in the setting of acute myocardial ischaemia, has turned during the last decade toward the potential prognostic value of markers of autonomic activity. Two of these markers, heart rate variability and baroreflex sensitivity, have gained progressive popularity. This chapter reviews some of the experimental observations that were instrumental for the novel clinical approach to post-myocardial infarction risk stratification based on the use of autonomic markers as risk stratifiers. It then focuses on clinical studies with special attention for a very recent multicentre prospective study (ATRAMI) carried out in almost 1300 post-myocardial infarction patients and aimed at the evaluation of the prognostic value of both heart rate variability and baroreflex sensitivity. Finally, some pathophysiological considerations are added to clarify the legitimacy, or lack of it, of the terminology currently used in clinical studies based on autonomic markers.